We present a case of polyserositis as a possible adverse drug effect to antiviral treatment.
A 74-year-old woman diagnosed with hypertension treated with manpinx and irbesartan/ hydrochlorothiazide, hypothyroidism treated with levothyroxine and chronic HCV genotype 1b on antiviral treatment with ombitasvir/paritaprevir.
After two weeks of antiviral treatment, the patient came to the emergency department with general malaise, vomiting (especially at the beginning of treatment), weakness, tiredness, dyspnea with progressive worsening, manifesting lower limb edema and fever in the last few days.
On arrival, she presented tachypneic fever of 38 °C and tachypnea.
Complementary tests included hypoxemia (pH = 7.49 mmHg; pCO2 = 28 mmHg; pO2 = 41 mmHg), leukocytosis (leukocytosis: 17.70 μL / globin: 20 μM· 103/ dL).
Regarding cardiac markers, a brain natriuretic peptide (NT Pro-BNP) value of 1,355.8 pg/mL was obtained.
Viral load was undetectable (< 15 IU/mL).
A chest X-ray showed bilateral interstitial infiltrate and transthoracic echocardiography (TTEE), and pericardial effusion was observed.
Clinical Intensive Care Unit compatible with multiple serous membranes isolated simultaneously (peritoneal, pericardium, etc.) as a possible adverse effect to antiviral medication, it was decided to discontinue treatment.
Because of respiratory failure, it was decided to start broad-spectrum antibiotic therapy after culture extraction and serology, which were later confirmed as negative.
Given the suspicion of autoimmune disease, the Rheumatology Department was consulted for the study of polyserositis.
Familial Mediterranean Fever (FFM) was ruled out; the patient did not present skin lesions or fulfilled the usual age of onset of the disease.
Antinuclear antibodies (ANA) and anti-DNA were determined, and 24-hour urine samples were collected to rule out systemic lupus erythematosus (SLE) connective tissue disease.
Corticosteroid pulses were started for 3 days, progressive improvement.
Analytical analysis showed positive ANA titer 1/160, which were considered not significant taking into account the personal history of hypothyroidism.
Anti-DNA antibodies were negative and proteinuria levels detected were < 1 gram in 24-hour urine.
It was decided to hospital discharge, considering the ADR resolved when the patient was asymptomatic, without dyspnea or respiratory distress.
The patient had a normal blood count and undetectable VC (< 15 Ul/ml), continuing with home treatment and descending corticoids.
After the first assessment by the Digestive Service, one month after hospital discharge, normal liver function was observed: TPG (ALT) 17.9 U/L and OGTT (AST) 28 U/L, continuous bilirubin 0.50 mg.
